That’s what Asheley Skinner, an associate professor medicine at Duke University, and her colleagues found when they analyzed obesity data from national surveys over the past 15 years. Since 1999, rates of overweight and obesity, as measured by body mass index (BMI) from children’s height and weight, have continued to steadily increase. In the latest survey, conducted from 2013 to 2014, 33% of children were overweight, and 26% were considered obese.

The prevalence of overweight and obesity increased steadily year by year from 1999 to 2014. For overweight, it went up from 28.8% in 1999 to 33.4%, and for the least severe type of obesity, from 14.6% to 17.4%.

Even more concerning, the trend has also worsened among the most severely obese: children with BMI readings greater than 40 for their age group. The prevalence of this type of obesity increased from 0.9% in 1999 to 2.4% in 2014.

The uptick comes despite more public awareness about the health risks of excess weight. In recent years, public policies have been put into place to reduce risk factors for obesity, such as elimination of trans fats from certain foods and improvements to school lunch. “What this tells me is that for kids with severe obesity, they aren’t being helped by small or single interventions,” says Skinner. “Choosing small things and doing small things is not enough for kids with severe obesity.”

What’s needed, she says, is more coordination between doctors in the health care system and communities so that a child’s environment is more conducive to healthy living. For example, health insurance may pay for a visit to the doctor to treat diabetes, a consequence of obesity, but it won’t pay for a membership to the local Y where children can get exercise to keep their weight in control. What these data show, says Skinner, is that “obesity requires thinking at every level, and thinking across the entire population.”